| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| BRANDON PENKO3 Filed as: BRANDON SIMON | PO BOX 3725 COEUR D ALENE, ID 83816 | UNITED HERITAGE LIFE INSURANCE COMPANY | $18K | $0 | $18K | 4.60% |
| ACRISURE LLC3 | UNKNOWN COEUR D ALENE, ID 83816 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $30K | $15K | $45K | 42.70% |
| JORDAN TEDESCO3 | 1412 6TH AVENUE N SEATTLE, WA 98109 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $6K | $1K | $7K | 7.02% |
| WORKSITE BENEFITS GROUP INC3 | 112 NW 114TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $3K | $4K | $7K | 6.73% |
| BENEFITS BY DESIGN INC3 | 2101 NE 279TH STREET RIDGEFIELD, WA 98642 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $4K | $2K | $6K | 6.03% |
| GABRIEL ANGEL CANALS3 Filed as: GABRIEL CANALS | 1549 NW CIVIC DRIVE, APARTMENT 204 GRESHAM, OR 97030 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $886 | $2K | $3K | 3.10% |
| MELLONEASE KIRKSEY3 | 1664 CEDAR SPRINGS COURT CLARKSVILLE, TN 37042 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $416 | $3K | 2.62% |
| MJ INSURANCE3 Filed as: ROXANA BUSCHMAN AND VARIOUS AGENTS | 400 NE 149TH STREET VANCOUVER, WA 98685 | COLONIAL LIFE & ACCIDENT INSURANCE COMPANY | $2K | $422 | $3K | 2.54% |
No Schedule C service providers reported on this filing.
Benefits declared on the Form 5500 main form (✓ = also has a Schedule A insurance contract; otherwise the benefit is funded out of plan assets or via a Schedule C TPA).
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 402 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 402 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Life insurance | UNITED HERITAGE LIFE INSURANCE COMPANY | 402 | $399K |
| Short-term disability | UNITED HERITAGE LIFE INSURANCE COMPANY | 402 | $399K |
| Long-term disability | UNITED HERITAGE LIFE INSURANCE COMPANY | 402 | $399K |
| Other(2 contracts, 2 carriers) | UNITED HERITAGE LIFE INSURANCE COMPANY | 402 | $504K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 402 | — |
Why the numbers differ. Form 5500 line 6 counts employees + retirees + beneficiaries; no dependents. Schedule A persons-covered counts everyone enrolled, including spouses and children, so it usually exceeds line 6 by 30-60% on a working-age workforce. The medical row is normally the broadest single line because it has the highest take-up; dental/vision/life often dip below it. Stop-loss / reinsurance contracts sometimes report the carrier's full underwriting pool rather than this filer's headcount; the row is shown for transparency but shouldn't be read as "people in this plan."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.